Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis
BackgroundThe objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).Materials and methodsThis observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC...
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Frontiers Media S.A.
2023-12-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1281432/full |
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| author | Milly Buwenge Gabriella Macchia Letizia Cavallini Letizia Cavallini Annalisa Cortesi Claudio Malizia Lorenzo Bianchi Lorenzo Bianchi Maria Ntreta Alessandra Arcelli Ilaria Capocaccia Ilaria Capocaccia Elena Natoli Elena Natoli Savino Cilla Francesco Cellini Francesco Cellini Luca Tagliaferri Lidia Strigari Silvia Cammelli Silvia Cammelli Riccardo Schiavina Riccardo Schiavina Eugenio Brunocilla Eugenio Brunocilla Alessio Giuseppe Morganti Alessio Giuseppe Morganti Francesco Deodato Francesco Deodato |
| author_facet | Milly Buwenge Gabriella Macchia Letizia Cavallini Letizia Cavallini Annalisa Cortesi Claudio Malizia Lorenzo Bianchi Lorenzo Bianchi Maria Ntreta Alessandra Arcelli Ilaria Capocaccia Ilaria Capocaccia Elena Natoli Elena Natoli Savino Cilla Francesco Cellini Francesco Cellini Luca Tagliaferri Lidia Strigari Silvia Cammelli Silvia Cammelli Riccardo Schiavina Riccardo Schiavina Eugenio Brunocilla Eugenio Brunocilla Alessio Giuseppe Morganti Alessio Giuseppe Morganti Francesco Deodato Francesco Deodato |
| author_sort | Milly Buwenge |
| collection | DOAJ |
| description | BackgroundThe objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).Materials and methodsThis observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson’s comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed.ResultsA total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox’s regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008).ConclusionsThe unexpected results of this analysis could be explained by a “response shift bias” concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens. |
| first_indexed | 2024-03-08T23:57:14Z |
| format | Article |
| id | doaj.art-de27e2d2c43b4a289c105c48b0058f5e |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-08T23:57:14Z |
| publishDate | 2023-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-de27e2d2c43b4a289c105c48b0058f5e2023-12-13T04:36:22ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-12-011310.3389/fonc.2023.12814321281432Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysisMilly Buwenge0Gabriella Macchia1Letizia Cavallini2Letizia Cavallini3Annalisa Cortesi4Claudio Malizia5Lorenzo Bianchi6Lorenzo Bianchi7Maria Ntreta8Alessandra Arcelli9Ilaria Capocaccia10Ilaria Capocaccia11Elena Natoli12Elena Natoli13Savino Cilla14Francesco Cellini15Francesco Cellini16Luca Tagliaferri17Lidia Strigari18Silvia Cammelli19Silvia Cammelli20Riccardo Schiavina21Riccardo Schiavina22Eugenio Brunocilla23Eugenio Brunocilla24Alessio Giuseppe Morganti25Alessio Giuseppe Morganti26Francesco Deodato27Francesco Deodato28Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyRadiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyRadiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, ItalyNuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyMedical Physics Unit, Gemelli Molise Hospital, Campobasso, ItalyFondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy0Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, ItalyFondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, ItalyDepartment of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyRadiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy0Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, ItalyBackgroundThe objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).Materials and methodsThis observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson’s comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed.ResultsA total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox’s regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008).ConclusionsThe unexpected results of this analysis could be explained by a “response shift bias” concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens.https://www.frontiersin.org/articles/10.3389/fonc.2023.1281432/fullprostate neoplasmsobservational studytoxicitypredictive factorsradiotherapyadjuvant therapy |
| spellingShingle | Milly Buwenge Gabriella Macchia Letizia Cavallini Letizia Cavallini Annalisa Cortesi Claudio Malizia Lorenzo Bianchi Lorenzo Bianchi Maria Ntreta Alessandra Arcelli Ilaria Capocaccia Ilaria Capocaccia Elena Natoli Elena Natoli Savino Cilla Francesco Cellini Francesco Cellini Luca Tagliaferri Lidia Strigari Silvia Cammelli Silvia Cammelli Riccardo Schiavina Riccardo Schiavina Eugenio Brunocilla Eugenio Brunocilla Alessio Giuseppe Morganti Alessio Giuseppe Morganti Francesco Deodato Francesco Deodato Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis Frontiers in Oncology prostate neoplasms observational study toxicity predictive factors radiotherapy adjuvant therapy |
| title | Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis |
| title_full | Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis |
| title_fullStr | Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis |
| title_full_unstemmed | Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis |
| title_short | Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis |
| title_sort | unraveling the safety of adjuvant radiotherapy in prostate cancer impact of older age and hypofractionated regimens on acute and late toxicity a multicenter comprehensive analysis |
| topic | prostate neoplasms observational study toxicity predictive factors radiotherapy adjuvant therapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1281432/full |
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